Gliederung

Question: Despite increased understanding of peripheral nerve regeneration, and theoretical merits of improving physical navigation by, for example, surgically aligning fascicles, the clinical results remain disappointing. Previous studies have used various conduits such as collagen, silicon and poly-L-lactide to promote regeneration of the main trunk of the facial nerve. A major contributing factor is extensive collateral branching at the lesion site which leads to inaccurate axonal navigation and aberrant reinnervation of targets. Among the various types of biological conduits that have been used for bridging peripheral nerve defects, considerable attention has been devoted to arterial 51 and venous 52–56 grafts. They appear to promote directional regeneration of axons from their cut ends, provide a conduit for diffusion of neurotropic and neurotrophic factors secreted by the damaged nerve stumps and minimize infiltration by fibrous tissue. We aimed to determine whether the isogenic aortic Y-tube improved axonal regrowth and whether this was associated with improved function.

Results: We found that, following facial nerve injury, the degree of collateral sprouting at the injury site was reduced by the use of an aortic Y-tube during reconstructive surgery compared to direct coaptation alone. However, this did not result in a reduction in the extent of polyinnervation at the motor endplate nor in improved whisking function.

Cocnlusions: The data suggest that reducing collateral branching using a Y-tube during surgical reconstruction after facial nerve injury does not confer any added functional benefit.

[This study was supported by TUBITAK (The Scientific and Technical Research Council of Turkey, project number: 109S462), Jean-Uhrmacher-Foundation (S.K.A.)]